Neal Bhatia, MD: Spotlighting Misconceptions, Approaches to Managing Actinic Keratosis

Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research and chief medical editor for Practical Dermatology, spoke with the HCPLive team on his 2024 Winter Clinical Dermatology Conference talk ‘What's New and Hot in AK Management.’

Bhatia first discussed some of the steps necessary for dermatologists in helping patients with actinic keratosis.

“The first step is really about having the conversation with the patients,” Bhatia explained. “A lot of dermatologists use the term precancerous, you know, but we don't really focus on the consequence of skin cancer as being why we need to treat it. I make the running joke about pre-cancer being kind of like pre-boarding at the airport. It's still technically boarding, whether you like it or not. And pre-diabetes is kind of a TV term, as it's really essentially metabolic syndrome or one step of hyperglycemia.”

Bhatia noted that the reality is that if actinic keratosis is untreated, it will also cause clinicians to miss the 10 that could be on their way.

“The bigger problem is that the risk of squamous cells, maybe in the range of less than 10%, but about 80 - 90% of squamous cells had actinic keratosis as a precursor,” Bhatia said. “So I make the running analogy about hockey, how it's always bad to lose a hockey game 1 to 0, and you never want to have that one be the one that beats it. So I think, more so in terms of treatment, we have to have a conversation with patients about what we are doing to protect them in the sun.”

Bhatia stressed the necessity of examination of actinic keratosis by dermatologists and clinicians in general.

“And then what photo protection strategies are being used besides sunscreen?” Bhatia asked. “Things like clothing, polypodium leucotomos, and some of the other extracts and things that go along with it. Then, of course, the algorithm for treatment is really different from what the guidelines show. The guidelines from the Academy are actually not very salient to daily practice, so I think what we need is an algorithm.”

Bhatia continued along this train of thought regarding an algorithm for helping patients to manage actinic keratosis. On the first day with a patient, Bhatia stated, clinicians may set them up for photodynamic therapy when schedules allow.

“When the patient schedules the second date, then you want to treat within that time with some sort of topical agent,” Bhatia explained. “Again, tirbanibulin is nice because the ointment is applied 5 days in sequence, but the reaction lasts about 15 days. 29 days they are really quiet, but then the benefits will last, which is really what we want out of a topical therapy.”

For any further information on Bhatia’s conference talk, view the interview above.

The quotes contained in this summary were edited for clarity.